“Secretly, medical professionals refer patients with mental health problems to my traditional healing office. In public, the same people call me a witch and exclude my profession from receiving benefits under the Universal Health Coverage scheme.”
This statement was made earlier this year by Lydia Matoke, the President of the Herbalist Society of Kenya, during a visit to the Kisumu County Government. She has experienced this ambivalent partnership for many years despite the reality that she successfully treats patients with psychiatric disorders.
In fact, the majority of persons with experience of mental health problems in Kenya seek help primarily from traditional and spiritual community healers rather than from trained medical professionals in institutional settings.
Kenyan studies estimate that about five million Kenyans, approximately 10 percent of the general population, are affected by some form of mental disorder.
With about 85 active clinical psychiatrists, there is one doctor for every 590,000 individuals, with the majority of psychiatrists working in urban settings. But the number of traditional healers is much higher. The popularity of these non-conventional practitioners can also be attributed to various other factors such as shared community values and beliefs, a more flexible payment structure as well as stigma around mental illnesses, shared by the state and the general public.
Furthermore, psychiatric disorders in their most severe forms, such as suicide attempts, are punishable by law in Kenya. Affected persons perceive the risk of prosecution to be higher in medical facilities than in traditional healing settings. What these people are looking for and what they really need is treatment rather than further punishment.
Moreover, experiences from the colonial past, such as the ethnopsychiatric analyses by British psychiatrist J. C. Carothers, have disrupted trust and confidence in the medical system.
The pathology derived of the Mau Mau people by Carother’s work was used as a tactic for suppression by British and Kenyan colonial regimes to quell the Mau Mau Uprising.In 2017, President Uhuru Kenyatta laid out his “Big Four” strategic objectives.
Alongside enhancing manufacturing, food security and nutrition, and affordable housing, his administration also focuses on implementing Universal Health Coverage (UHC) to improve health in society, accelerate development, and reduce poverty.
People with experience of mental health problems and their caregivers oftentimes do not have the financial resources needed to be diagnosed and treated in medical facilities or by community workers. UHC covers mental health services – in institutions and at the community level.
Being insured can therefore help those affected to cover the direct costs, e.g., fee for consultation or payment for medication associated with mental illness.
In addition to these costs, the patient’s indirect financial burden, including but not limited to unemployment, cannot be underestimated. UHC can help to offset some of these costs, too.
Patients who receive regular treatment and are medically stabilized will be able to successfully reintegrate in their communities and take active part in securing prosperity for their societies.
If the majority of patients with psychiatric disorders were seen by trained medical professionals and community workers, UHC would reach its goals.
The writer is consultant expatriate with Kisumu County government.